Zhang Zhen, Zhou Lei, Cheng Zongsan, Zhang Xiaoma
Department of Urology, The First Affiliated Hospital of Anhui Medical University, 100 Huaihai Road, Hefei, Anhui, 230000, China.
Department of Urology, Anhui Public Health Clinical Center, 100 Huaihai Road, Hefei, Anhui, 230000, China.
Urolithiasis. 2025 Jan 3;53(1):19. doi: 10.1007/s00240-024-01690-0.
Retrograde intrarenal surgery (RIRS) is recognized as an effective intervention for renal stones measuring less than 20 mm. This study aims to assess the efficacy and safety of a novel flexible kidney-fixed position compared to the conventional lithotomy position, focusing on lithotripsy efficiency and stone-free rates (SFR). A total of 100 patients undergoing unilateral RIRS between January 2023 and September 2024 were randomly allocated to either the conventional lithotomy position group or the kidney-fixed position group. Comparative analyses were conducted on demographic data, stone characteristics, intraoperative parameters, kidney movement metrics, and postoperative complications. A total of 97 patients successfully completed the study, with 47 participants assigned to the conventional lithotomy group and 49 to the kidney-fixed group. The kidney-fixed position was associated with a significant reduction in kidney movement (4.00 mm compared to 15.30 mm, p < 0.001) and a decrease in operative time (48.35 min versus 71.72 min, p < 0.001). Additionally, the SFR for stones measuring ≤ 4 mm was significantly higher in the kidney-fixed group (91.84% compared to 68.09%, p = 0.020). The implementation of a flexible kidney-fixed position markedly improves the efficacy of lithotripsy during RIRS, resulting in reduced operative time and an elevated SFR without a corresponding increase in postoperative complications. This technique holds promise for advancing the surgical management of renal calculi, warranting further investigation to substantiate these findings and assess long-term outcomes.
逆行性肾内手术（RIRS）被认为是治疗直径小于20毫米肾结石的有效干预措施。本研究旨在评估一种新型柔性肾脏固定体位与传统截石位相比的疗效和安全性，重点关注碎石效率和无石率（SFR）。2023年1月至2024年9月期间接受单侧RIRS的100例患者被随机分配到传统截石位组或肾脏固定体位组。对人口统计学数据、结石特征、术中参数、肾脏移动指标和术后并发症进行了比较分析。共有97例患者成功完成研究，其中47例分配到传统截石位组，49例分配到肾脏固定组。肾脏固定体位与肾脏移动显著减少（4.00毫米对比于（传统截石位的）15.30毫米，p<0.001）以及手术时间缩短（48.35分钟对比于71.72分钟，p<0.001）相关。此外，≤4毫米结石的无石率在肾脏固定组显著更高（91.84%对比于68.09%，p=0.020）。采用柔性肾脏固定体位显著提高了RIRS期间的碎石效果，缩短了手术时间，提高了无石率，且术后并发症没有相应增加。该技术有望推动肾结石的手术治疗，值得进一步研究以证实这些发现并评估长期疗效。
